This blog began in 2007, focusing on anthrax vaccine, and later expanded to other public health and political issues. The blog links to media reports, medical literature, official documents and other materials.

Sunday, April 5, 2015

Lots of babies get measles in Africa and India, and it is a significant cause of death there. A great deal of work has gone into developing measles vaccines that can be given to children at younger and younger ages, especially in Africa, for this reason.

But in the United States, endemic measles has been eliminated. It does not circulate here, except when a case arrives from overseas. Yet here too, the recommended age for a first measles vaccine has been changed over time. It used to be 15 months; now it is 12 months.
Actually, measles is not endemic anywhere in the Americas (yes, the entire Western Hemisphere) because public health agencies, especially the Pan American Health Organization, have vaccinated children in the farthest reaches of Latin America. The public health systems have done a great job of controlling the spread of measles cases, when they appear from overseas. Even in the poorest countries of our hemisphere, measles (as well as mumps and rubella) has not reestablished endemicity. [And, since Third World countries have handily controlled the spread of measles measles, one expects the CDC to have no difficulty doing the same here.]
The only way to absolutely prevent all measles cases is to close your borders, and no one suggests doing that. Fewer than one person per million in the Western Hemisphere gets measles each year.
In Europe, Africa and Asia the measles situation is different. But we are here.
It has long been known that the younger you are when you receive a measles vaccine, the less likely you are to achieve immunity. For example, in a 1978 CDC article published in the journal Pediatrics, Walter Orenstein (later director of the US National Immunization Program) et al. wrote:

... we carried out a case control study of vaccine failure in a recent measles epidemic. Compared to children vaccinated at ages 15 months or older, we found an increased risk of vaccine failure among those vaccinated at 12 to 14 months (relative risk = 19.2, 95% confidence interval = 4.6 to 80.1). In order to sort out the influence of age at vaccination from elapsed time since vaccination, we subjected the data to discrminant analysis. Age at vaccination subsumed all of the effect of duration of time since vaccination. Thus, we find no evidence of waning immunity over time.

In 1963, the recommended age for vaccination was 9 months, but in 1965 it was changed to 12 months, and in 1976 it was changed to 15 months because of evidence demonstrating greater efficacy when children were vaccinated at these ages. Persons vaccinated before the first birthday needed to be revaccinated.

This range of [measles vaccine] effectiveness also can be attributed to age at vaccination (i.e., the 85% vaccine effectiveness represented children vaccinated at age 12 months, whereas the ≥94% vaccine effectiveness represented children vaccinated at age ≥15 months.

What may be less well known is that if you receive your first measles vaccination at a young age, you are probably less likely to gain strong immunity from subsequent doses of measles vaccine, compared to those who received their initial measles vaccine at a later age.
Canada had a large measles outbreak in 2011. There were over 750 cases in the province of Quebec alone, five times as many cases as the Disneyland epidemic.
In a study of one school which had 110 measles cases, about half the children who developed measles had received two or more MMR doses, and about half were unvaccinated.
In efforts to understand the high rate of vaccine failure, it was found that children in the school who received their first MMR dose between 12-14 months had a vaccine failure rate of 7%, while children who received their first dose at 15 months or older had a vaccine failure rate of only 2.5%.

"Although unvaccinated people should
remain the prime target for measles
vaccination, the unexpected vulnerability
we have identified in twice vaccinated
people could ultimately
lead to failed measles elimination
efforts. If the effect of early vaccination
permanently alters the ability
to respond to subsequent doses, even
adding a third or fourth dose may
not provide long-lasting protection.
Therefore, it is critical to understand
the mechanisms of primary vaccine
failure or loss of vaccine protection
that our findings may signal."

The US is not like Africa when it comes to measles. No babies have died from measles in the US for more than 15 years. We can afford to wait a few months to give the first MMR dose, and optimize vaccine-induced protection for our children. If we are going to take the risks inherent in using any vaccine or drug, we owe it to ourselves to maximize the benefits we can gain from them.
Delaying the MMR for 3 months appears to be a much more effective way to optimize herd immunity than increasing the number of doses, or reducing exemptions. CDC surely knows its directive to give the MMR at 12 months has increased the number of vaccinated Americans susceptible to measles, probably several-fold. Why hasn't CDC acted on this knowledge, and revised the age for giving the first MMR?In fact, were it to do so, there might not even be a need for the second MMR, according to Orenstein's 1978 article.Instead of admitting this problem and moving forward,

Might Dr. Anne Schuchat not know what Dr. Walter Orenstein and others at CDC know about the best age to start MMR? It's not likely, because they worked together at CDC for many years; because each has been the director of the National Immunization Program; and furthermore, because they have co-written several articles on vaccines.* But note the incestuous relationship between CDC and Merck:

CDC has ignored its own measles vaccine science, with increased vaccine sales but reduced population immunity the result. Which begs the question: who do CDC and Dr. Schuchat really work for?

After a number of separate lab mishaps at CDC that exposed scientists (with no knowledge or warning) to live bird flu, anthrax and Ebola, CDC's director had an advisory committee look into the matter. In January, the committee concluded that CDC lacked a "culture of safety." Given all the above, should we be blindly taking CDC's advice? **

Instead, a CDC housecleaning is in order, with the goal of promoting the development of more effective and safer ways to vaccinate.

* In addition to serving on the National Vaccine Advisory Committee together, Drs. Schuchat and Orenstein have co-authored the following papers:

**CDC lacks a culture of safety. Just 3 months ago, an advisory committee to the CDC Director issued its recommendations to improve safety at CDC. The report began with the following words: "Observation: Leadership commitment toward safety has been inconsistent and
insufficient at multiple levels. Safety, including lab safety, is viewed by many as
something separate from and outside the primary missions of public health and
research."
The committee's final observation began: "We are very concerned that the CDC is on the way
to losing credibility. The CDC must not see itself as "special." The internal controls and
rules that the rest of the world works under also apply to CDC."

After swimming with dolphins at Key Largo, they checked me out at the edge of the pool

Visiting a Bhutanese Dzong, the regional seat of both government and religion (and a fort for good measure)

Why am I blogging?

Because life is meant to be lived! The left side of this blog has photos of some peak experiences. And the right side contains information about which I am passionate.

Too many peoples' lives are characterized by lack of authenticity, and fear of acknowledging and expressing their true nature. Employees cannot say what they think at work, and in the corporate system we must squish ourselves into square holes when we are round pegs. We thus lose touch with our souls, becoming cogs in a soulless, profit-driven machine.

The culture of political correctness has meant, in medicine, that we ignore how the foundations of our science are being undermined by commercialism. Clinical data generated or presented by the manufacturers of drugs, vaccines and devices cannot be trusted: there are hundreds of studies proving this. But this fraudulent information continues to be the only data informing the approval of vaccines, drugs and devices.

Unless scrupulous ethical conduct is demanded of physicians and biological scientists, our lack of meaningful standards will carry the medical-pharmaceutical system down the path of increasing irrelevance.

Medicine and its tools need to be affordable. The current medical-industrial milieu, characterized by contempt for science, countless ways for insiders to achieve wealth due to failure of good governance, and regulatory agency-to-industry revolving doors, has ushered in stratospheric pricing... further kicking us down that path to irrelevance.

Why is our new health care plan a giveaway to health industries instead of to health consumers? Why won't it cover all Americans? Why was the "public option" never an option for the Obama administration? Why did the promised Trump health plan evaporate the moment he was elected?

So many of our leaders carry a heavy burden of mendacity and avarice. If they instead got in touch with their own souls (perhaps by exposure to the natural world), or made their decisions by maximizing the amount of good that results, our leaders might find real meaning and value in their lives.

Until that happens, the only way to straighten out the current mess is to demand accountability and impose penalties on unethical/dishonest leaders. Both political parties enjoy bounteous hors d'oeuvres from Pharma's table, making it unlikely the existing political "process" will provide relief--as we've seen in the demoralizing healthcare reform drama.

Until then, I'll continue to "call it as I see it" in this blog -- working and living the way life should be, in rural Maine, far from the centers of power.

Ellen Byrne has created several designs encapsulating aspects of the FBI's ridiculous case against Bruce Ivins. They can be purchased on T-shirts and coffee mugs. All proceeds will be donated to the the Frederick County chapter of the American Red Cross, a favored charity of Dr. Bruce Ivins.